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HomeMy WebLinkAbout030-1083-10-002 (2) / 0 \ I § � ƒ � ] � » ) § k 7 U. ) § 7 §E I z _ f 2 m / \ a 0 B z :t c ) k k / \ E \ \ 7 Cl) f \ 2 ) $ / $ I 3 t z ] z 0 I t \ k « E 7 ^ Co A L _ S \ § k k \ ° \ U) U) § £_ Z, C . k § U)k ® z \ § a a a ) 0 j §\ \ k k z ' D a 2 § \ ƒ \ \ o E $ IL § { I L 2 2 t 3 \ % a J m R §0 _■ _§ / c }k \\ S k § § § § k @ ) ) k 7 5 / / � ; 2 a s z z a g § ® � , 3 6 \ k 3 G 0 V) k § i f Cl) q / ie a o z / e w ■ m � I a e l e a , M E Z % f w E e , i k J a 2 ' 0 2 2 , - � r y �IYV4S`Nl ,3T-) x.'11.(...:- ",Tt1e-. Ya0%J •,'..: ' T T. ' iytt i9d l Do .lhm 3060 maq MAMMON QQ it 1�y = VE IW Wa twoo" In juvol vn� islet "MR: SRI, meat 11)71 51!'11 ;� ..',)' ,?�.C.. r C COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 4cak kt� 715 - 962 - 3121 800 - 962 5227 ST. CROIX ZONING REPORT NOA 00811/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 1/24/90 COURTHOUSE DATE RECEIVEDt 1/23/90 HUDSON, WI 54016 ATTN: THOMAS C, NELSON! r'r 16f-3- D 9� 2 3 OWNER: Jon & Kim Gilbertson LOCATION: Houlton 14 COLLECTOR: Ci Zi SOURCE OF COLIFORNit 0 /100 ml INTERPRETATIONt Bacteriologically SAFE NITRATE--Mit t 1 ppm Under 10 ppm is safe for human consumption, Coliform Bacteria/100 al Nitrate-Nitrogen, mg/L a(' Ss )( d)AL C. -�r�Cc 1t-S F10.64-V- cast tits 549 4c, S,-f LT Ia --nktl 4o 4 e s+. moon u3u l LAB TECHNICIANS Pas Game WI Approved Lab No# 19 �� J Y�1 �.\NDEVEND0, Means "LESS THAN Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 0V ST. CROIX COUNTY ZONING OFFICE 5T' d St. Croix County Courthouse j 2 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Coaglpt ign of this form is essenti'� so that thwroAerty can be located. please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATERTESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria)FEE: $175.00 WATER TESTING (For VOC'S) ---FEE: $25.00 SEPTIC SYSTEM INSPECTION-------------- (Determines if system is properly functioning at t me of inspection) Property owner's name ,�0 � - l',�+�'1 11 �t 2 �` 1 t'�P"� 82 Property owner's address 13750���� 1 +.�T�J-�-- Legal Des ription yes 1/4 of the Kl &-_i/4 o Section �_, T3oN N-R�vV' Town of tAmftn Lot Number kt _Subdivision Nameoc FIRE NUMBER BOX Nt?MRER Color of house L©!� _Realty sign by house? If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. II Firm or individual requesting services: , Telephone Number i.3REPORT TO BE SENT TO• V Closing da ► CA Signature Y` SOMERSET .:� FLOG WmF- _��...__� PW LU tfwl NI 3 3?5.. rvX RID&S 11MIL. - OVLm ToN how �5'-I 15D WT d ST. CROIX COUNTY 4 WISCONSIN KJ7 ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 (715) 386-4680 January 24, 1990 Mid-America Bank 600 2nd St. Hudson, WI 54016 Dear Sir: An inspection of the septic system of Jon and Kinberlie Gilbertson, 1375 Fox Ridge Trail, Houlton, WI was conducted on January 23, 1990. At the same time I also obtained a water sample and submitted it to the laboratory for testing. The results of that testing will be sent to you as soon as we recieve them back from the laboratory. At the time of the _inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of the system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator cj Parcel #: 030-1083-10-002 12/13/2006 03:47 PM PAGE 1 OF 1 Alt.Parcel#: 29.30.19.299E 030-TOWN OF SAINT JOSEPH Current X,' ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner JON C T&KIMBERLIE C GILBERTSON 0-GILBERTSON,JON C T&KIMBERLIE C 1375 FOX RIDGE TR HOULTON WI 54082 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description ' 1375 FOX RIDGE TR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 4.440 Plat: N/A-NOT AVAILABLE SEC 29 T30N R19W SE NW THAT PART OF LOT Block/Condo Bldg: 11 OF CSM 5/1414(PORTION OF LOT 11 CSM 5/1414 LOCATED IN HUDSON SCHOOL Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) DISTRICT) 29-30N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1014/66 07/23/1997 738/479 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 169230 361,300 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.440 118,800 194,700 313,500 NO Totals for 2006: General Property 4.440 118,800 194,700 313,500 Woodland 0.000 0 0 Totals for 2005: General Property 4.440 118,800 194,700 313,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 140 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 spi, 2 19 Form - STC - 104 • AS BUILT SANITARY SYSTEM REPORT JAN OWNER CST l 1130 T'S DA) TOWNSHIP S�' d S6 P SEC. Z T '�dN-R W ADDRESS F7 ' x ST. CROIX COUNTY, WISCONSIN / t SUBDIVISIONS � LOT l( LOT SIZE 'S i PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 1 ' SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM � I'I i DU -5— 7� INDICATE NORTH ARROW suQ�? y0� S /0e16,J P/' dAd BENCHMARK: Describe the vertical reference point used $C�Tr� LOr Elevation of vertical reference point: o�� Proposed slope at site: �0 SEPTIC TANK: Manufacturer: 46A)64'� 1_ Liquid Capacity: Number of rings used: � Tank manhole cover elevation: /0,57, 7 S- / Tank Inlet Elevation: /a7 Tank Outlet Elevation: Number V feet from nearest Road: Front,©Side,O Rear, O feet From nea est property line Front 0 Side 10 Rear,0 �a feet. will trot /A/ �o— JVA7E Number of feet from: well building: 2-I 2 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE r PUMP CHAMBER a Manufacturer: Li Capacity: Pump Model: Pump/S on Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch a ation: Gallons per cycle: Alarm Manuf urer: Alarm Switch Type: Numbe of feet from nearest property line: Front, O Side, O Rear,Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: +�j}` �:p Width: � r Length: C�� Number of Lines: Area Built: Fill depth to top of pipe: 7 y l 3 Number of feet from nearest property .line: Front, O Side, Rear,0 Ft . Number of feet from well: W ELL aO 0 Wk: Y&I-",. Number of feet from building: Q / (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevati Area Built: Has either a drop box O or distribution bo been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK ' Manufacturer: Capacity: Number of ri used: Elevation of bottom of tank: Elevati of inlet: ber of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: I Inspector• Dated: S / / Plumber on job: License Number: HUMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT VIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. 3/84:mj ;'rN.INSTALLER&DESIGNER LIC.NO.00663 offs T , s �L A.) e6 colt, Ce �chS� gC71,00 � 2�f�L t/ouxf a I s i I ,I I � LT� � Of I I j I 9G.�3 • 5 ySTEM O'T S oZ) s ysr�H erl = y6. d HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT WIS.MASTER PLUMBER LIC.N0.3307 M.P.R.S. ,AiNN.INSTALLER&DESIGNER LIC.NO.00663 i So v !o T �I �� lvi1S/f�D 31, it Jf f�it't fjjE ��ilJ��1 2 Z� P/s7", �!p • W i d NO ' AeilleP 70 !!l7r DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING P.O.BOX 7969 MADISON,WI 53707 'CONVENTIONAL ❑ALTERNATIVE Slate Planl.D.Number W2j NE%, Section 29 "'a"'g"�°' T30N-R19W, Town of St. ❑Holding Tank ❑In-Ground Pressure ❑Mound Joselph, Valley View INSPECTION DA E: NAME OF PERMIT HOLDER ADDRESS Of PERMIT HOLDER: Jon & Kim Gilbertson 1421 Ward Avenue, Hudson, WI 54016 (Q-D3 -27 BENCH MARK Wermanenl reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF PT.ELEV. . Name of Plumber IMPIMPRSW No.. County: Samlary Parma Number: Robert Ulbricth 3307 1St. Croix 106118 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV._ PAOVIID DLABEL PROVIDED OVER [SYES ❑NO ❑YES NO PROPERTY WELL. BUILDING VENT 70 FRESH BEDDING. VENT Of VENT ATL. HIGH WATER NUMBER OF ROAD: L E. qIR INLET ALARM FEET FROM ML❑YES 9NO ❑YES - NEAREST rCJ�a g' DOSING CHAMBER: MANUFACTURER 71�NGS LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDEDE ❑NO Y ❑ ❑YES -]NO GALLONS PER CYCLE: PUMP AND CONTROLS OPE RATIONAL: NUMBER OF PROPERTY W LL BUILDING VENT TO E FRESH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMErEH M RIAL A D RKING FORCE or excavation. (If soil can be rolled into a wire,construction shall cease until the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF IDISTR PIPE SPACING COVER NSIUE DIA aPITS OQTIIU p THEN ES MATERIAL: PIT DIMENSIONS G 8 '. (P 1 GRAVEL DEPTH FILL DEPTH UISTH PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DI R. NUMBER OF PROPERTY WELL BUILDING VENT TOFRESH BE�/OW PIPES. ABOVE COVER. ELEV.INLET ELEV.END'. PIPES LINE AIR INLET (�I FROM /t * / NEAREST r �� MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. 1-1 YES El NO SOIL COVER TEXTURE PERMANENT MARKERS OHSEH NATION WELLS EY ES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES El YES 0 N OYES ONO El YES NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH-. LENGTH. NO.OF LATERAL SPACING (TRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV.. CIA.. ELEV.. PIPES DIA.. ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS OYES. ONO ❑YES 0 N COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LUEPtHI WELL: BUILDING. FEET FROM O 10 1 ❑YES 1:1 NO ❑YES 1:1 NO NEAREST J3.3S I 3 2.3 13 . 33 Sketch System on Retain in county file for audit. Reverse Side. TITLE SIGNATURE. Zoning Administrator DILHR SBD 6710(R.01/82) i - 70 SANITARY PERMIT APPLICATION CO U TY DILHR In accord with ILHR 83.05,Wis.Adm.Code S . ao / STATE SANITARY PERMIT# -Attach complete plans(to the county copy only) or the system,on paper not less than /a �/� Y) Y P P STATE PLAN I.D.NUMBER 8%x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROPERTY OVVNER , �+ PROPERTY LOCATION 70.E 1 /� vi�/;'•.ln f�D"� &V yj,1A %, S Zf T 79 N, R E (or nw PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME If 2 f W 1419- csrt (/Of- S CJTY,STATE ZIP ODEr PH�O�NyE NUMBER CITY NEAREST ROAD If Vi ro� �j' �3�0 Z ❑ VILLAGE : ��. f�2&TO4N 04- II. TYPE OF BUILDING OR USE SERVED: �--�lJ�/- ZD OOtl Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a.XNew b.❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a.4 Conventional b. ❑Alternative C. 1:1 Experimental 2. a.`❑_System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) Z G%,c,Ff 1. a. ❑ seepage Bed b.9 Seepage Trench c. ❑seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 15.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): / O 7 S 0 �(� Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total ##of Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xi sting Gallons T Manufacturer's Name anks Concrete stCon- glass App. Tanks Tanks Septic Tank or Holdina Tank Y 120 ❑ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's ignature:(No Stamps) MP/MPRSW No.: Business Phone Number: R . 7,t 1 b�.i'C�T— ��f Le,� 3 3 0 7 ?�S 3��• �'l� Plumber's Address(Street,City,State,Zip Code: Name of Designer: Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name M SIT SEPTIC PLUMBING CO. EPhoneNumber: �- 655 O'NEIL RD.,HUDSON,WIS.54016 CST's ADDRESS(Street,City,State,Zip Code) WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. IX. COUNTY/DEPARTMENT USE ONLY r��y, ❑ Disapproved Sanitary Permit Fee Groundwater a�Te Issuing Agent Signature(No Stamps) L�Approved El Owner Given Initial S charge Fee Adverse Determination f 26,(D6 X a, UU �tJ O�<, X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION ' TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to•this permit must•,be approved�by the pbrmit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms,etc,), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399)to be submitted to the county prior to installAtibn; x _; 5. Private sewage systems mustibe properly maintainer The septic tanks) should be pumped by a Licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact our local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; r VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed; number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphgn chamber and holding tanks,for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must:sign application form. Fill in designer name if applicable; VIII. Soil test informatiop: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to-scale or with complete,dimensions, location of holding tank(s), septic tank(s) or°bther treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 Corm. GROUNDWATER SURCHARGE . . On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate, The groundwater bill Ground a: :r included the creation of surcharges (fees) for a number of regulated practices which Wiscor4i $ can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rE''c'1 rQ is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) I APPLICATION FOR SANITARY PERDied STC - 100 This application form to be completed in full an the owner(s) of the property being develope ill only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------------- Owner of property Y Location of property r' /" �- 1/4, Section , T 30 N-RZf—W Township Mailing address f�Z/ A471X® 4'e - tfu P-no 'y 4)l'- Address of site Subdivision name Lot number Previous owner of property / '� :57 Total size of parcel O ! kcivt Date parcel was created �� 3 Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house)? Yes x No Volume ` 3, and Page Number tf as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warrant deed rj!��ded in the Office of the County Register of Deeds as Document No. ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as' Document No. ) . T051�� 11 L:;iEf Sign tune of Owner Sign a of Co-Owner ( plicable) Date of Signature D of Signature w. p t 4 (W} Af of '-Lot B + pi ( . of ctr � P •€:' "► tiro 1414. o d6 fp�t aan i s loc.Ea# i the C +'Af of r-ga2f of-*fist if ust t� :.1�d : 3�. �a d7a4� :'i�l 1 G�Ct #ad durrroy wS�ir "d4i"• 133; voles. "Sw• Pap ti s v pull aw 6we �nb "d �e-.ftw n"Mumb wY = y irt�t tv a.r�. tiv ..--.--._..�BtiAI�) .... •f' ........................... ('Sl,AL) •--- ............... ................... ...; , STATS OF WISCONSIN r T� � P � .. `tf� ;g# •� .._--.M��,- .�� *y.rti::a..i�:y�s`.t' M�`i'fbC ¢ A .K§ f F• {� � f t r STC - 105 n}; SEPTIC TANK MAINTENANCE AGREEMENT St . Croix County - a OWNER/BUYER LAI ROUTE/BOX NUM ER °��z'�. � �� �/ -" Fire Number F r` �^- CITY/STATE ls ZIP U�� Al� k r PROPERTY LOCATION: Section T N. R A w � N 57 Town of St . Croix �" �6� /dip � �•, �� �< '� Subdivision - , Lot. number • x� t Improper use and maintenance of your septic system could reul.t its premature failure to handle wastes . Proper maintenance Son- , sists of pumping out the septic tank every three years or Sooner, if needed, by a licensed septic tank pumper. What you putt into the system can affect the function of the septic tank as a -treat- went stage in the waste disposal system. i , t St . Croix. County residents m_�' be eligible to receive a gr$AC �o�c AV-, to r; 4 a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St. Croix Cquaty t .. ; accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. a The property owner agrees to submit to St . Croix County Zonln# g .@ certification form, signed by the owner and by a master pjqpber, Journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper, operating condition and (2) after inspection and pumping (it nec- essary) , the septic •tank. is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days ,prior, to three year expiration. k ' s± I/WE, the undersigned; have read the above requirements a0'"&'ree n figa to maintain the private sewage disposal system in accordaace: with the standards set forth, herein, as set by the Wisconsin Depart- ` went of Natural Resources . Certification form must be completed and retwrned to the St . Croix County Zoning Off:kge within 30 day& of the three year expiration date. V SIGNED DATE i St . Croix County Zoning Office :; ; P.O. Box 98;- Hammond, WI 54015 715-796-22 39 or 715-425-8363 Sign, date and return to above address. ' DEPART?YIENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION L MADISON,WI 53707 ABQR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS (H63.090) &Chapter 145.045) LOCATION: SECTION: TOWNSHIP�MWA}F6FPAWTY: LOT NO.:BLK.NO.: SUBDIVISION NAME: 5r y, 1/ j-9 /T3®N/R/9E(or)W 5T• JosEP/f— /b COUNTY: OWNER'S R'S NA MAILING ADDRESS: , ST•ci�°oiX i v f,�i 'f,B i so,v /y�,/ !W,'D Aoe • h�vDSov Avis• S'f�oi� USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: ROFILE DESCRIPTI NS: PERCOLATION TESTS: Residence Y /v�- A New ❑Replace I / � ?6 0 RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) KS ❑U ZS ❑U ®S ❑U ❑S U OS �U 7W,044s Q f If Percolation Tests are NOT required DESIGN RATE: Q � I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: e�S s Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- l�/0, V to , y/' > /yo ' .s'-0K 13,x. S, �. ,�. e� 7 e-13 rya' /�,9� - ,�yo ' io' 4K. Av- /S, 33 N'yy !07 �,v. p , >�o ' /.o' •qf! 13,v• s 7 ti- , 3 AV, S ' i u D , ,u B- rLlll X05.'70 — >/y✓ F l C w;x eovwx is � g� ' � Af C&f . e� /3.SG� �/3 S . 33 '11i,' 1014y s, X67 ' 9y ^BN• s /S 'Aflx.A'a go B- x4 3A). c s PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 RI PER INCH p_ Z• �' Z f P- i P- Z P-_ P-d I Y.6 LF I Z - P�— PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. A A d SYSTEM ELEVATION �C0' Fr t � . 1 �.� ► C� D S , , it tN a � i 1 h1t t_ a114 P r a c nv n oral #is � t_ I� _ _. . _ 1 . 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, , NAME(print): TESTS WERE COMPLETED HOMESITE SEPTIC PLUK4BING CO. ,e// 22 ^ ` a ADDRESS: RT,3O'NEIL RD., CERTLEICATION NUMBER: PHO E NUMBER(ooptti ional): ROBERT ULBRICHT CST SIGNATUR MINN.INSTALLER&DESIGNER LIC,NO.00663 1 DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — INSTRUCTIONS FOR COMPLETING; FORM 115 - SRO - 5395 To be a complete and accurate soil test,your report mUSt include; 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or c€rrnmercial use planned; 4. Is this a new or replacement system; 5. Complete the scrltability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6 PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7, MAKE A LEGIBLE diagram accurately loeatirrg your test locations. Drawing to scale is preferred, A Sel)arate sheet may be usedt if desired; S. Ariake sure your benchmark and vertical elevation reference point are clearly shown,and are pei manent; 9, Complete all appr'op)iate boxes as to dates, names,addresses, flood plain data, percolation test:exemp- tiosa, i E apprnl�}r iate; 101 if the ;nforniation (such as flood plain,elevation)does riot apply, place N,A, in the appropriate box; 11. Sign the form arad place your current address and your certification number; 12, 1?Iak4: Ieclihle copies and distribute as required. ALL SOIL. TESTS MUST BE FILED WITH THE LOCAL AUTHORITY Y WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (c_zver 10") I:R - Bedrock c€ h - Cobble (3- 10") SS Sandstone c r - Gravel (under 3") LS Lin7estone .s - Sand HGW - High Gromidwatei c" - Coarse Sand Perc _- Per colation Bate; med - ivlediuns wand I s Fine, San d bid a ... Building is - Loaony Sand Greater 1-hsn si _ Sandy Loan < L ss Than "i L01111i Bn - Brown 0 S!!t. Loam Ill Black S Silt Gy G ray c;l - Clay Loan-i Y - Yellow sc,l - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sir - Silty clay fff few, Fine,faint C - Clay cc - raornnlon,coarse, pt Pe.-' ;nrn Many, rneE ium of - r"uck d - dist:inct. p prominent Htrt1L High water level, Six general soil textures surfaces water for liquid waste disposal BM Bench (hark VRP - Vertical Reference Point TO TIME OWNER: 1nis sot tryst repa)rt is the first step in serrm'i ( .a sanitary perrrdl, The county or the L ppmtrnent may request "lccation of hl is soil test if, the fir lit prior :t; peon issu,:,i ce, A complete; sf,t of plans for the. private . Wsi.emi aInd a e},:"tiirj clop'lica'tion, !Y't CISt he St,St}t1°rECt"ed to the arm,"rwrlate local authorky in order tO i;r s;jj ;te.r"q r,leFn"iii mk, r hf;of),iined and posted pi for to the start of any �:tior), REPORT ON Soil f3oRiN&S PERCOLATION TESTS 115- PLor PLAN PRo3-Ec i =. C) f 10 fon iPio�e BOB cs r s .-02 y�Z PROPOSED movSE mosr LIE Z;, Fr• 04 M "0,4f AL TEST ft�PEgS, PROPOSED W L a M vsr LIE 50 FT. Ole /YORE FiPoiy ,pct TEsT B,¢ jf�D�c P�Tf Q = EXisnW e.- WELL AL Aeve f R� ERED o S� HAAJ� D!!E[ /.3 9 �Es � u / O U yoeiz . BNB rfic Fv0, To / �P�f 41 � AL �PEFERt�lIE' 7` 9 00 gr nor ��ZO�C ,tS k iP LEGEN D e1AVAr1dA1 < r. �PfF Pr goo. o fr YO pt 0 �iPoPos�� � 1 I P.,T /� Bjj - 3� - T3,. PRA V O D{tK5 o ZO i .5 Eo v n .0 . . O eta 1 55 pp?R .G cyst •to t\ � BE � ,S test ti�Ora�Sep � C a CI yen On poi- #/o Sn, tof Lave 1 let c �� r DUATMENTOF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION UMA AND PERCOLATION TESTS (115) P.O. BOX 7969 Hf1AAN RELATIONS \ 1 U MADISON,WI 53707 IH6IMI)&Chapter 145.045) TOWNSHIPFMNNi6iAA6I•*Y; OT NO.:BLK.NO.: SUB�DDIIV,IISION NAME: t - 4 ' �/ J-9 %T.3°N/R&E(orl w sT oSE/o/t— �d f o1� wv�C T -s CO_COUNTY: A AD SS: ST►�I 60 ,� .;,t�i;u ./,B�i sov /y�, l ,ww Avg • hruprov his• s'polr,,p USE DATES OBSERVATIONS MADE Residence O R TION: R F S: 17 Ao ESTSp: ;t* / New ❑Replace I / RATING:S-Site suitable for system U-Site unsuitable for system y2 ` n,671A" ONVE MOUND: IN-GROUN :S S E -IN-FILL GILDING TANK:RECOMMENDED SYSTEM:(optional) Els ou zS ❑U • ®S DU ❑S BU CIS ©U % -� r5 •w xoti If Percolation Teats are NOT required DESIGN RATE: If any portion of the tested area is in the �`•� under s.H63.09(5)(bl,indicate: � s S �� I Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL NUMBER DEPTH Iry ELEVATION T N P H R UDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH OBSERVED ES TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) r e-�4 I�!o �P, yr' �- > /yo • •s'� s, �. � A. > /o�4f 4,,. iS, 7 33` N- Y- l07 �r F/f_T /oS. >/ !` o f q�e wst,ucoe (s B-j 1r3 Sao' - 7� ' s . 3,3 "41k MY- S /.G 7 ' qy --Av. s B. AN- c s PERCOLATION TESTS I TEST DEPTH ' WATER IN HOLE TEST TIME DROP IN WATER L V L-INCHES RATE MINUTES NUMBER INCHES AFTERSWELUNG INTERVAL-MIN. p I PER1651 PER INCH P. P- P. lee I P •yj L PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the horn zontal and vertical elevation.reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of lend slope. SYSTEM ELEVATION T�E� -s _ r , I--- L i- fit Arl I ' so:/ die. I I 1,the undersigned,hereby certify that the soil tests reported on this fo/m were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAM print `1 TESTS WERE COMPLETED ON: ADD HOINESITE SEPTIC KLINIBING CO. e%� W.30NEIL CERT�ICATION NUMBER: PHO NUMBER(optionall: ROBERT U86.N . S"S DL KP3 3 MINN.INSTALLER&DESIGNER LIC.NO.00663 CST SIGNATUR (DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. nIL HR-SOD-6395 9/R 'ld (� obi o� ,.07 td SA40 IT ass ,S8 -7/7 01 W-7j S�l s • ------ o� --- . 1 M Q nodo& • 1-j O '0 0/ W .4v /rou'VAYI; 4 N 39 31 / 2rfa v a'� w �oz-p/ 4V-o e; $P-X-L -*Y0 47 / $ �o,L 4rrno�l -trwa/ .��r_�a�3�.�� w�i`I�3/� W8 • ziyoy , � �� _ s�xo� 7��ys �'� 0.��►3d nd �"�'y = � sihoir�ao� ��..�� � k 77%f(77 -9(YZ1SW .3*"Y>ba = • �Sy3�6� 1f,�1 7�i� NO�� j�Oh/ d►0 li 05 a ri .15o w -n3M 0 35od osd 3y0W Yo 1� St all 1SOW 3SM4 0350JONJ ZJIA IrT)1N.7717 909 x! i t iz 31 VC • o3tobd WVI o D1 ! 1 1 moo,� Xo� O� � ��✓' d d .SII 51591 Nolld10)b9d S�NI8Dfl "1105 NO 12iod32! 3 SiAiE APOPo%o -bROP ROK N, All I r S' X CaCp ' 1 1 S♦R+E D 1 1 1 ; ptJE 1 �pPR 1 / S t p t• T A t_rcRAWT 1 40rEsgk AP-e K QCoat�.e¢,C Ga . 1 1 It i 1 ' r � J SCALE:- 1 = 2— -- vt--RT. Rod`TE51 : e 13 S�Ru oN j go- 1 � � Su RuEyo>?S �/e V( : �00•d 2 5 T, P. W. ohKS [Poo \ V W e)1- Li NA _-a pa.opoSED well -}v lie T Yc), fRom T-Peac4x5 25 I -FROM S E p f 1'e 2 � Ty PiC^t FOPL 3dYtt T R Ems+ � e S v Fresh Air Inlets And Observation Pipe � h �] 0 Approved Vent Cap Minimum 12° Above Final Grade � A4 / a 0, 0 3& Above Pipe — 4" Cast Iron , Vent Pipe -to Final Grade Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe • Distribution Tee Pipe 0 0 0 0 0 S O�1 ^1E� 4 Aggregate o Perforated Pipe Below ,DES. T Beneath Pipe 0 Coupling Terminating At 1 16 . 0 Bottom Of System Parcel #: 030-1081-70-001 12113/2006 03:46 PM PAGE 1 OF 1 Alt. Parcel#: 29.30.19.294C 030-TOWN OF SAINT JOSEPH Current X! ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner JON C T&KIMBERLIE C GILBERTSON O-GILBERTSON,JON C T&KIMBERLIE C 1375 FOX RIDGE TR HOULTON WI 54082 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 4.430 Plat: N/A-NOT AVAILABLE SEC 29 T30N R19W SW NE THAT PART OF LOT Block/Condo Bldg: 11 OF CSM 5/1414(? DESC. IN VOL 738/479(PORTION IN SOMERSET SCHOOL Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) DISTRICT)738/479 29-30N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 738/479 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 169215 26,600 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.430 23,100 0 23,100 NO Totals for 2006: General Property 4.430 23,100 0 23,100 Woodland 0.000 0 0 Totals for 2005: General Property 4.430 23,100 0 23,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00